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Anatomy of the lower limb II – Vascular anatomy Pr. Philippe PELISSIER Service de Chirurgie Plastique Centre F.X. Michelet CHU de Bordeaux www.e-plastic.fr Lower limb anatomy - Vessels Gluteal region Femoral artery Popliteal artery Lower-leg region Veins ans lymphatics Lower limb anatomy - Vessels Gluteal region Femoral artery Popliteal artery Lower-leg region Gluteal region Lower limb anatomy - Vessels Ant Med S Add L TFL F a. RF Add L : adductor longus m. Add B : adductor brevis m. FL : fascia latae F a. : femoral a. GM : gluteus maximus m. IG : inferioris gemellus m. IP : ilio-psoas m. LC a. : lateral circumflex a. LO : lateral obturator m. MO : medial obturator m. Pe : pectineus m. Pi : piriformis m. S : sartorius m. SG : superior gemellus m. RF : rectus femoris m. VL : vastus lateralis m. Sci : sciatic n. Add B VL IP Pe FL LC a. LO MO Sci GM (After Caix) Gluteal region – Horizontal section Gluteal region Lower limb anatomy - Vessels Cranial Ventral GM G med G min FL : fascia latae (ilio-tibial tractus) GM : gluteus maximus m. G med : gluteus medius m. G min : gluteus minimus m. IG a. : inferior gluteal a. Pi : piriformis m. MO : medial obturator m. Sci : sciatic n. SG a. : superior gluteal a. SG a. Pi IG a. MO Sci (After Caix) Gluteal region – Parasagital section Gluteal region G min : gluteus minimus m. IG a. : inferior gluteal a. Pi : piriformis m. Sci : sciatic n. SG a. : superior gluteal a. Lower limb anatomy - Vessels G min SG a. Pi IG a. Sci (After Caix) Gluteal region – Dorsal view Gluteal region Lower limb anatomy - Vessels Superior gluteal artery Origin • Iliac artery Terminal branches • Superficial branch : inner aspect of gluteus maximus m. • Deep branch : between gluteus medius m. and gluteus minimus m. G min SG a. Pi Sci (After Caix) Gluteal region – Dorsal view Gluteal region Lower limb anatomy - Vessels Inferior gluteal artery Origin • Iliac artery Terminal branches • Gluteal branch : vascularization of gluteus maximus m. • Femoral branch : muscular branches + sciatic nerve G min Pi IG a. Sci (After Caix) Gluteal region – Dorsal view Lower limb anatomy - Vessels Gluteal region Femoral artery Popliteal artery Lower-leg region Femoral artery Lower limb anatomy - Vessels Ant Med RF VI VM Add L : adductor longus m. Add B : adductor brevis m. Ad M : adductor magnus m. BF lh: biceps femorali m. (long head) BFsh : biceps femorali m. (short head) Gr : gracilis m. RF : rectus femoris m. S : sartorius m. SM : semimembranous m. ST : semitendinous m. VI : intermedius m. VL : vastus lateralis m. VM : vastus medialis m. S F Add L Add B VL BF sh Ad M BF lh Gr SM ST (After Caix) Thigh region – Transversal section Femoral artery Lower limb anatomy - Vessels Ps Ps IL IL TFL TFL Add L : adductor longus m. Gr : gracilis m. IL : iliacus m. Ps : psoas m. RF : rectus femoris m. TFL : tensor fascia latae m. VL : vastus lateralis m. VM : vastus medialis m. VI : vastus intermedius m. Add L Gr Add L VI Gr RF VL VM VL VM (After Caix) Thigh region – Frontal view Femoral artery Lower limb anatomy - Vessels Femoral artery Origin • Below the inguinal ligament Course • Vertical in the femoral triangle • Deep position in the femoral canal Terminal branches • Hiatus of the adductus magnus m. (After Caix) Thigh region – Frontal view Femoral artery Lower limb anatomy - Vessels Femoral artery Origin • Below the inguinal ligament Course • Vertical in the femoral triangle • Deep position in the femoral canal Terminal branches • Hiatus of the adductus magnus m. Collateral branches • Superficial epigastric a. • Superficial circumflex a. • Pudendal a. • Deep femoral a. • Genu desscendens a. (After Caix) Thigh region – Frontal view Femoral artery Lower limb anatomy - Vessels Femoral artery Origin • Below the inguinal ligament Course • Vertical in the femoral triangle • Deep position in the femoral canal Terminal branches • Hiatus of the adductus magnus m. Collateral branches • Superficial epigastric a. • Superficial circumflex a. • Pudendal a. • Deep femoral a. • Genu desscendens a. (After Caix) Thigh region – Frontal view Femoral artery Lower limb anatomy - Vessels Femoral artery Origin • Below the inguinal ligament Course • Vertical in the femoral triangle • Deep position in the femoral canal Terminal branches • Hiatus of the adductus magnus m. Collateral branches • Superficial epigastric a. • Superficial circumflex a. • Pudendal a. • Deep femoral a. • Genu desscendens a. (After Caix) Thigh region – Frontal view Femoral artery Lower limb anatomy - Vessels Femoral artery Origin • Below the inguinal ligament Course • Vertical in the femoral triangle • Deep position in the femoral canal Terminal branches • Hiatus of the adductus magnus m. Collateral branches • Superficial epigastric a. • Superficial circumflex a. • Pudendal a. • Deep femoral a. • Genu desscendens a. (After Caix) Thigh region – Frontal view Femoral artery Lower limb anatomy - Vessels Femoral artery Origin • Below the inguinal ligament Course • Vertical in the femoral triangle • Deep position in the femoral canal Terminal branches • Hiatus of the adductus magnus m. Collateral branches • Superficial epigastric a. • Superficial circumflex a. • Pudendal a. • Deep femoral a. • Genu desscendens a. (After Caix) Thigh region – Frontal view Lower limb anatomy - Vessels Gluteal region Femoral artery Popliteal artery Lower-leg region Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. (After Caix) Thigh region – Frontal view Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. Collateral branches • Superior and lateral artery of the knee • Superior and medial artery of the knee • Inferior and lateral artery of the knee • Inferior and medial artery of the knee • Medial sural a. • Lateral sural a. • Muscular branches (After Caix) Thigh region – Frontal view Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. Collateral branches • Superior and lateral artery of the knee • Superior and medial artery of the knee • Inferior and lateral artery of the knee • Inferior and medial artery of the knee • Medial sural a. • Lateral sural a. • Muscular branches (After Caix) Thigh region – Frontal view Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. Collateral branches • Superior and lateral artery of the knee • Superior and medial artery of the knee • Inferior and lateral artery of the knee • Inferior and medial artery of the knee • Medial sural a. • Lateral sural a. • Muscular branches (After Caix) Thigh region – Frontal view Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. Collateral branches • Superior and lateral artery of the knee • Superior and medial artery of the knee • Inferior and lateral artery of the knee • Inferior and medial artery of the knee • Medial sural a. • Lateral sural a. • Muscular branches (After Caix) Thigh region – Frontal view Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. Collateral branches • Superior and lateral artery of the knee • Superior and medial artery of the knee • Inferior and lateral artery of the knee • Inferior and medial artery of the knee • Medial sural a. • Lateral sural a. • Muscular branches (After Caix) Thigh region – Frontal view Popliteal artery Lower limb anatomy - Vessels Popliteal artery Origin • Hiatus of the adductus magnus m. Course • Vertical • Median axis of the poplietal fossa Terminal branches • Fibrous arcade of soleus m. Collateral branches • Superior and lateral artery of the knee • Superior and medial artery of the knee • Inferior and lateral artery of the knee • Inferior and medial artery of the knee • Medial sural a. • Lateral sural a. • Muscular branches (After Caix) Thigh region – Frontal view Lower limb anatomy - Vessels Gluteal region Femoral artery Popliteal artery Lower-leg region Lower-leg Lower limb anatomy - Vessels Ant Med TA EDL EDL : extensor digitorum longus m. EHL : extensor hallucis longus m. FDL : flexor digitorum longus m. FHL : flexor hallucis longus m. GL : gastrocnemius m. (lateral head) GM : gastrocnemius m. (medial head) PB : peroneus brevis m. PL : peroneus longus m. TA : tibialis anterior m. TP : tibialis posterior S : soleus PL Tibia EHL TP PB FDL FHL S GL GM (After Caix) Lower-leg region – Transversal section Lower-leg Lower limb anatomy - Vessels Anterior tibial artery Ant Origin • Fibrous arcade of soleus m. Med TA Course • Vertical • Between interosseous membrane and tibialis anterior m. EDL EHL Tibia TP PL PB FDL Terminal branches • Dorsalis pedis a. FHL S GL GM (After Caix) Lower-leg region – Transversal section Lower-leg Lower limb anatomy - Vessels Anterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between interosseous membrane and tibialis anterior m. Terminal branches • Dorsalis pedis a. Ciollateral branches • Fibular circumflex a. • Recurrent anterior tibial a. • Recurrent anterior fibular a. • Muscular branches (After Caix) Lower-leg region – Frontal view Lower-leg Lower limb anatomy - Vessels Anterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between interosseous membrane and tibialis anterior m. Terminal branches • Dorsalis pedis a. Ciollateral branches • Fibular circumflex a. • Recurrent anterior tibial a. • Recurrent anterior fibular a. • Muscular branches (After Caix) Lower-leg region – Frontal view Lower-leg Lower limb anatomy - Vessels Anterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between interosseous membrane and tibialis anterior m. Terminal branches • Dorsalis pedis a. Ciollateral branches • Fibular circumflex a. • Recurrent anterior tibial a. • Recurrent anterior fibular a. • Muscular branches (After Caix) Lower-leg region – Frontal view Lower-leg Lower limb anatomy - Vessels Anterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between interosseous membrane and tibialis anterior m. Terminal branches • Dorsalis pedis a. Ciollateral branches • Fibular circumflex a. • Recurrent anterior tibial a. • Recurrent anterior fibular a. • Muscular branches (After Caix) Lower-leg region – Frontal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Ant Med TA EDL EHL Tibia TP PL PB FDL Terminal branches • Plantar arteries FHL S GL GM (After Caix) Lower-leg region – Transversal section Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Terminal branches • Plantar arteries Collateral branches • Fibular a. - origin 3 cm below popliteus m. - Lies on the interosseous membrane - Runs deep to TP and FHL m. (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Ant Med TA Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches EDL EHL Tibia TP PL PB FDL FHL S GL GM (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Ant Med TA Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches EDL EHL Tibia TP PL PB FDL FHL S GL GM (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches (After Caix) Lower-leg region – Dorsal view Lower-leg Lower limb anatomy - Vessels Posterior tibial artery Origin • Fibrous arcade of soleus m. Course • Vertical • Between tibialis posterior m. and soleus m. Ant Med TA Terminal branches • Plantar arteries Collateral branches • Fibular a. - Bone feeding branch - Muscular branches - Ramus perforans - Communicating branch of fibular a. - Postero-lateral malleolar a. • Bone feeding branch (tibia) • Posteo medial malleolar a. • Muscular branches EDL EHL Tibia TP PL PB FDL FHL S GL GM (After Caix) Lower-leg region – Dorsal view Lower limb anatomy - Vessels Veins and lymphatics Veins and lymphatics Lower limb anatomy - Vessels Venous drainage Deep network • External iliac vein • Femoral vein • Popliteal vein • Anterior tibial vein • Posterior tibial vein • Fibular vein (After Caix) Lower-leg region – Dorsal view Veins and lymphatics Lower limb anatomy - Vessels Venous drainage Deep network • External iliac vein • Femoral vein • Popliteal vein • Anterior tibial vein • Posterior tibial vein • Fibular vein Superficial Network • Accessory saphenous vein • Great saphenous vein • Lesser saphenous vein (After Caix) Veins and lymphatics Lower limb anatomy - Vessels Venous drainage Deep network • External iliac vein • Femoral vein • Popliteal vein • Anterior tibial vein • Posterior tibial vein • Fibular vein Superficial Network • Accessory saphenous vein • Great saphenous vein • Lesser saphenous vein (After Caix) Veins and lymphatics Lower limb anatomy - Vessels Venous drainage Deep network • External iliac vein • Femoral vein • Popliteal vein • Anterior tibial vein • Posterior tibial vein • Fibular vein Superficial Network • Accessory saphenous vein • Great saphenous vein • Lesser saphenous vein (After Caix) Veins and lymphatics Lower limb anatomy - Vessels Lymphatic drainage (After Caix)
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